Published in:
Open Access 01-11-2019 | Acute Kidney Injury | Reports of Original Investigations
Incidence and predictors of myocardial and kidney injury following endovascular aortic repair: a retrospective cohort study
Published in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Issue 11/2019
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Purpose
We performed a retrospective cohort study in patients who underwent endovascular aneurysm repair (EVAR) to determine the incidence and predictors of myocardial injury and acute kidney injury (AKI).
Methods
We included 267 consecutive patients who underwent EVAR at two tertiary centres in Canada and Poland. The primary outcome was myocardial injury during hospital stay after EVAR defined as a troponin elevation (ultra-sensitivity troponin I Vidas ≥ 19 ng·L−1, non-high-sensitivity troponin I Vidas ≥ 0.01 µg·L−1, high-sensitivity troponin T ≥ 20 ng·L−1, non-high-sensitivity troponin T ≥ 0.03 ng·mL−1). The secondary outcome was AKI defined using the stage 1 of the Acute Kidney Injury Network criteria.
Results
Myocardial injury occurred in 78/267 patients (29%; 95% confidence interval [CI], 24.1 to 34.9) and with AKI occurring in 25/267 (9.4%; 95% CI, 6.4 to 13.5). In a multivariable analysis, the following variables were associated with an increased risk of myocardial injury: age (adjusted odds ratio [aOR], 1.65 per ten-year increase; 95% CI, 1.09 to 2.49), Revised Cardiac Risk Index score ≥3 (aOR, 2.85; 95% CI, 1.26 to 6.41), The American Society of Anesthesiology physical status score 4 (aOR, 2.24; 95% CI, 1.12 to 4.47), duration of surgery (aOR, 1.27 per each hour; 95% CI, 1.00 to 1.61), and perioperative drop in hemoglobin (aOR, 3.35 per 10 g·dL−1 decrease; 95% CI, 1.00 to 11.3). Predictors of AKI were duration of surgery (aOR, 1.72 per hour; 95% CI, 1.36 to 2.17), a preoperative estimated glomerular filtration rate (eGFR) of 30-59 mL·min−1 (aOR, 3.82; 95% CI, 1.42 to 10.3), and an eGFR < 30 mL·min−1 (aOR, 37.0; 95% CI, 7.1 to 193.8).
Conclusion
Myocardial injury and AKI are frequent during hospital stay after EVAR and warrant further investigation in prospective studies.